4.30 pm

Mr. Hammond: The Minister may not realise that he is doing himself and his Government a disservice by quoting those figures, because people look at what is happening on the groundwhether they can get into hospital or get an appointment with their GP. Figures bandied about in Westminster or Whitehall mean nothing to them.

Would the Minister to go back to something that he said a few moments ago? He said that we are talking about a substantially increasing number of GPs, not about redistributing GPs. Each year, a significant number of GPs reach retirement age or leave the service for other reasons. Is he telling the Committee that there will not be a reduction in the number of GPs in any health authority area?

Mr. Denham: I would be surprised if there were a reduction in any health authority area. One can never be absolutely sure without seeing the detailed figures, population shifts and so on. Given that we are seeking to increase the number of GPs by 2,000 net over the period of the NHS plan, I hope that we will see expansion, but I think that there is a case for faster expansion in some areas of the country than others. However, I cannot give an absolute assurance, because I have not looked at every health authority and its circumstances.

The number of GPs in individual practices always varies over time: practices grow or shrink, partly because of the population base and partly for other reasons. The underlying point is that we are expanding the number of GPs. We have made it clear that we regard the figure in the NHS plan as a floor not a ceiling. If we can expand further, we will.

Mr. Hammond: The Minister will be aware that the NHS plan proposes significant improvements in access to service provided by GPs, and the Government suggest that an additional 2,000 GPs will be needed to achieve that. The British Medical Association suggests that it will need four to five times that number. Is not the logic of what the Minister is telling the Committee that the improvements in service proposed by the NHS plan will not be available to areas that the Government consider to be over-doctored or adequately doctored if he intends to target most new GPs to areas that he considers to be under-doctored?

Mr. Denham: I do not accept that. We believe that the number of GPs in the plan will be adequate to meet the access targets and service developments set out in the period of the plan. It is important to offer that high level of primary care access not just in some parts of the country but across the country as a whole and, in particular, in areas which, in relative terms, are under-doctored. We should always talk in relative rather than absolute terms when we talk about the development of GP practices.

Sir George Young: I am grateful to the Minister for addressing the issues that I raised when I initiated this debate. I have never disputed the assertion that a differential approach to resource allocation is necessary and I made it clear that areas that faced greater challenges should have more money. However, I queried whether 80 per cent. was the right figure and I quoted from a panel set up by the Minister, which found no evidence for such a wide disparity. The document from which I quoted is now in the safe hands of Hansard, so I cannot draw on it again. I am not sure that the Minister's reply dealt with the independent panel's comment that that variation of 80 per cent. could be substantiated.

I caution the Minister before he quotes what seem to be substantial figures. Each time that I hear an announcement from a Minister about substantial new resources for my local authority, health authority or police authority, I take the precaution of writing to the authorities to ask for their assessment of the announcement. I must say that their perception of the increase is not always the same as that of the Government. In this case, the Minister referred to huge increases in allocations to my health authority. I did exactly what I have just described, and the reply from the director of finance stated:

The headline figures give only the tip of the iceberg. The funding covers cost increase and improvements across the range of health spending including local and specialist hospital services, community services, GPs and prescribing costs.

The letter also stated:

The `general increase' (estimated at 4.9 per cent. for us) is intended to meet the pressure on pay, prices and the cost of implementing NICE recommendations etc. that all health systems will face.

Large increases in resources for all health authorities were announced in November, so I wrote to my health authority and asked whether that meant that they did not need to find savings of £13.5 million. The director of finance's reply stated:

As the funding announced for next year is in line with the assumptions underpinning `Meeting the Challenges'

that is the document looking for economies

the proposals remain valid.

In other words, the authority has been unable to change the proposals that it made earlier in the year as a result of the increased allocation. I add those words of caution because the public in my constituency are becoming suspicious of large figures broadcast by Ministers. They cannot reconcile big increases with the local situation, where the health authority is scratching around for £13.5 million in savings.

On a more positive note, the Minister was able to say that there will be no reduction in GPs, which is welcome. I do not wish to press my amendment to a Division, but I remain concerned about the application of a formula that the Minister's independent panel believes to be unfair to one section of the health service. I ask him to pause before he inflicts a formula that does not have wide support on part of the health service, primary care, that is working well. This is a Treasury-driven proposal to cash-limit that portion of the NHS budget that is not currently cash limited. The Treasury has being trying to do that for years, and it has succeeded under this Administration. I urge caution on the part of the Minister before he pushes that forward to primary care services. Nevertheless, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Hammond: I beg to move amendment No. 10, in page 1, line 21, at end insert

`(3AB) Prior to determining amounts under subsection (3) above or varying amounts under subsection (5) below, the Secretary of State shall publish details of the matters he shall take into account in accordance with subsection (3) or subsection (5) as the case may be and the way in which he will take them into account'.

The Chairman: With this it will be convenient to take the following: Amendment No. 9, in page 2, line 12, at end insert

`(2B) Prior to specifying an amount under subsection (1) above or varying an amount under subsection (6) below, the Secretary of State shall publish details of the matters he shall take into account in accordance with subsection (1) or subsection (6) as the case may be and the way in which he will take them into account'.

Amendment No. 19, in page 2, line 24, at end insert

`(1B) Prior to determining amounts under subsection (1)(b) above or varying amounts under subsection (3) below, the Authority shall publish details of the matters they shall take into account in accordance with subsection (1)(b) or subsection (3) as the case may be and the way in which they will take them into account'.

Amendment No. 21, in page 2, line 38, at end add

`(2B) Prior to specifying amounts under subsection (1) above or varying amounts under subsection (4) below, the Authority shall publish details of the matters they shall take into account in accordance with subsection (1) or subsection (4) as the case may be and the way in which they will take them into account'.

Mr. Hammond: Thank you, Mr. Maxton. We are all on a learning curve with these new arrangements, and I have no idea whether it was the Government's intention that the effect would be, in practice, to curtail debate of some clauses that are important to interested and knowledgeable bodies outside Parliament. In order that we should have an opportunity to discuss clause 17, it will be necessary for us to spend a moment only on this group of amendments.

The issues that the amendments seek to address have already been aired in the previous two debates. If the Minister is genuinely committed to a transparent process, which entails the use of formulae that can be clearly understood and applied consistently and fairly, I suggest that the amendments are necessary or, at the least, can do no harm. They simply set out a requirement that the Secretary of State will make public the matters that he takes into account when he makes his funding allocation, and the way in which he does so. That is parliamentary phraseology for publishing the formula. If the Minister's intends to make the formula public, perhaps he would be good enough to tell the Committee that he accepts the amendments.

Mr. Denham: We already publish details of the current health allocations

Mr. Denham: We already publish details of the current health allocations formula and that process is quite transparent. Everyone knows the formula and local target and the pace of change that has been achieved each year. We fully intend to continue that arrangement for the additional element in the formula proposed in the clause and when the main allocation formula is revised, I am sure that that will be the case. Unlike the right hon. Member for North-West Hampshire, I find the 99 health authorities remarkably good auditors of the process. They are quick to shout if they think that things are not fair or not working.

As drafted, the amendment would add an unnecessary bureaucratic element to what is actually a transparent process. Everyone can see every year what the Secretary of State has done and how he has done it.